Provider Demographics
NPI:1669024923
Name:BURGI, NATHANIEL SCOTT (PA)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:SCOTT
Last Name:BURGI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1055 N 500 W
Mailing Address - Street 2:ATTN CREDENTIALING
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3305
Mailing Address - Country:US
Mailing Address - Phone:801-354-8225
Mailing Address - Fax:801-418-0941
Practice Address - Street 1:2183 W MAIN ST STE A107
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-6761
Practice Address - Country:US
Practice Address - Phone:385-203-1215
Practice Address - Fax:801-418-0941
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPA61122689363A00000X
UT8327420-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant